Inspection on 11/10/07 for Newquay Nursing Home

This inspection was carried out on 11th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Newquay Nursing Home 25/02/09

Newquay Nursing Home 09/04/08

Newquay Nursing Home 25/06/07

Newquay Nursing Home 10/01/07

Newquay Nursing Home 27/06/06

Newquay Nursing Home 07/03/06

Newquay Nursing Home 17/11/05

Newquay Nursing Home 22/03/05

Newquay Nursing Home 24/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Newquay Nursing Home 55 Pentire Avenue Newquay Cornwall TR7 1PD Lead Inspector Kerensa Livingstone Unannounced Inspection 11th October 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Newquay Nursing Home Address 55 Pentire Avenue Newquay Cornwall TR7 1PD Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01637 873314 Mrs Mary Elizabeth Roy Mr Teelucksing Ram Persad Roy Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (41) of places Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To admit one named service user under the age of 65 years for respite for a period of approximately three months. Total number of service users not to exceed a maximum of 41 Date of last inspection 25th June 2007 Brief Description of the Service: Newquay Nursing Home is registered to provide accommodation and nursing care for up to 41 Service Users who fall into the categories of Old Age (OP), Old Age nursing (OP (N)), Physical Disability (PD) and Terminally Ill (TI). The home is situated on Pentire Avenue in Newquay and the location offers some of the service users a scenic view over the beach and out to sea, others can enjoy distant countryside views. Service user rooms are situated on the ground floor and the first floor. The Registered Provider is Mrs M E Roy and Mr T Roy is the Registered Manager. There is a shaft lift, which can take wheelchair users to the first floor. There is a small patio area to the rear of the building where Service Users can sit with a pergola. There is a small parking area to the front and rear of the building. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that was undertaken by one inspector over one day from 0900 until 17:30. The Inspector looked at records, care documentation, Policies and Procedures and inspected the environment. The inspector met with the Service Users, Registered Manager, staff and relatives. Case tracking and direct observation were used. The Registered Manager completed an Annual Quality Assurance Assessment (AQAA) prior to the inspection. Residents (10) and relatives (7) completed questionnaires; this information was gathered prior to the inspection. On the day of the inspection there were thirty-three residents residing at the home, including three who were in for respite care. The current fees range from £444.25 to £550.00. What the service does well: What has improved since the last inspection? Since the last inspection the Service User’s Guide has been reviewed to include the contract and complaint’s procedure. The complaint’s procedure has been updated to include the contact details for the Commission. The drugs fridge is being kept locked at all times. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 6 Following a requirement at the last inspection, changes have been made to ensure that the registered person does not pay money belonging to any resident into the home’s bank account. A Protection of Vulnerable Adults procedure including the local contact details has been compiled since the last inspection. Since the last inspection supervision records are being stored securely. Training in POVA, moving and handling, fire etc is being or going to be provided for all staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed information has been compiled about the home. The service user’s guide should be provided to all prospective residents. There is evidence that all Service Users are assessed prior to moving into the home to ensure that their individual needs can be met. EVIDENCE: The Service User’s Guide has been reviewed since the last inspection to include the contract and complaints procedure, this is available in each room with a copy of the most recent report. The resident’s views of the home are not included. This information is not provided to all prospective service users, to enable them to make an informed choice about whether the home meets their needs. One person commented they would have liked more information before they moved into the home. A copy is on the notice board in the reception area of the home. The statement of purpose provides detailed information. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 10 Each service user is provided with a statement of terms and conditions. This document includes the room to be occupied. The contracts include the breakdown of fees to show who is making what contribution. The Inspector observed evidence that a full assessment is undertaken for all new service users, usually by the Registered Manager. This should form the basis of the plan of care. There was evidence that additional information is gathered from the Department of Adult Social Care and/or a health assessment, depending on the individual’s needs. Intermediate care is not provided at this home. There are no designated rehabilitation facilities and staff are not received rehabilitative training. Respite care is offered. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The individual’s plan of care does not set out the health, personal and social care needs in an individualised way. They are inadequate to direct and inform care. Generally health care needs are met, access to Dental and Optical care must be improved. The procedures for the administration and storage of medicines are generally satisfactory. People’s privacy and dignity is respected. EVIDENCE: At the previous inspections the care plans inspected were core care plans (computer generated), some progress has been made in making some of them more individualised. The care plans are brief and do not provide the detail required to direct care. Some state “help wash and dress” this is not reflective of the individual needs, preferences, wishes and independence of the service user. These care plans do not fully guide care staff on how to support the service user’s own capacity for self care. The documentation inspected did not reflect the complexity of need and invariably key aspects of care were not included or updated, although there was a signature to confirm that the plan had been reviewed. Examples of this are where specialist advice has been Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 12 sought in relation to speech and language therapy, tissues viability and weight loss; the actions recommended by the specialist are not recorded into the care plan. The need for pressure relieving equipment was identified, however this was not included in the care plan. A risk of falls was noted on admission to the home, however no falls assessment was undertaken. Social, spiritual and psychological care needs were very rarely mentioned in any of the care planning documentation. There was evidence that some relatives had signed care plans, however generally there was little evidence to suggest that the resident and/or their representative is involved in the drawing up and reviewing of the plan of care. The care documentation is stored in an open office; all private and confidential information must be locked away. Prior to the person moving into the home, a needs assessment is undertaken by the registered manager. This information does not seem to be built upon to ensure that staff have a comprehensive needs assessment for each service user. The assessment tools evident were the Barthel Scale and a Residents Mobility and Handling Profile. As identified at the previous inspections, these were not consistently utilised. A waterlow assessment was recorded for all residents at the time of admission identifying the perceived level of risk for each resident. A nutritional assessment is undertaken on admission, although these did not seem to be developed where a need was identified. The inspector observed evidence that General Practitioners and District Nurses visit the residents, these are recorded in the care records. Advice is sought on an individual basis from the Tissue Viability Specialist Nurses and Speech and Language Therapy team. However, no visits were recorded of all the service users case tracked of visits by a Community Psychiatric Nurse, Occupational Therapist, Physiotherapist, Optician, Dentist or dietician. The Chiropodist visits residents every six weeks. Regular visits to the home by the Dentist and Optician have stopped, this was identified at the previous inspection and have not been recommenced to date. Pressure relieving aids were identified throughout the home e.g. air flow mattresses and cushions. There was limited/no evidence to demonstrate that continence is promoted within the home, continence assessments are not being undertaken for individuals. One individual was identified as being ‘ doubly incontinent’, there was no continence assessment and no entry in the care plan relating to this. All medication is administered by qualified nurses and a Monitored Dosage system is used. The lunchtime medication round was observed. The trained nurse on duty administers all medication, these must be dispensed directly from individual named packets or blister packs within the medication trolley to the service user. The trained nurse informed the inspector that this is the procedure that takes place throughout the 24-hour period. Medication Administration Records (MAR) completed in an appropriate manner. Generally the Medication Administration records (MAR) are pre printed by the pharmacist, when they are handwritten they should be checked and signed by a second person. Each resident has a photograph held on their medication Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 13 sheet to ensure their protection during the administration of meds. Records of medication received into the home and disposed of are kept. As recommended where medication is not administered by staff or declined by a resident the reason is being recorded. There are policies and procedures in place, these must be updated to include Homely Remedies. There is a designated fridge to store medication that requires this facility, temperatures are checked and recorded daily. This was locked on the day of the inspection. There is a Controlled Drugs (CD) cupboard and a CD register. These were observed to be accurate and records up to date. Residents need for privacy was observed to knock before entering bedrooms and bathrooms in most instances. The staff spoke to people respectfully. Residents informed the inspectors that they are treated with respect and their right to privacy is respected. There are Policies and Procedures relating to Privacy and Dignity and Choice. The double rooms are usually only occupied by two persons who express a wish to do so. Screening is provided in double rooms. The individual’s preferred names is recorded, however this was observed not always to be the name used. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities provided are not adequate to meet the individual and collective needs of all the service users. Service user’s choices in all aspects of daily life should be recorded. Visitors are welcomed to the home. Service users enjoy the variety and quality of the meals that are provided. EVIDENCE: At the previous inspection there was a designated member of staff for activities for three quarters of an hour per day for four days a week. This was an improvement since the previous inspection, but not adequate to meet the needs of the service users. However this is not currently happening. Residents commented that they missed the activities that had been started. No outings are being provided and none are planned. A record is kept of the activities and who participates in them. Resident’s interests should be recorded and plan of activities based upon these interests. Up to date information about activities should be circulated to all residents in a format that is suited to their capacities. It is recommended that the member of staff conducting activities be offered some training to help with this role. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 15 Several visitors visited the home throughout the inspection. Relatives and visitors informed the inspector that they were able to visit at anytime. The home has several seating areas and visitors were observed within the lounge, conservatory, reception hall and in service users own rooms. Staff appeared to have a good rapport with the visitors and appeared welcoming. The inspector found it difficult to evidence that service users had control and autonomy over their lives. Most Service Users monies are handled by a family member, limited amounts are available via the administration office. Service Users are able to bring in personal possessions and furniture with them. Most rooms are personalised. As identified at the previous inspection, the personal choices and wishes of Service Users must be documented in the records, these in turn should be reflected in the routines of the home. The opportunity for choice in relation to food, mealtimes, personal and social relationships, leisure and social activities and routines of daily living should be documented as part of the personal social history. This is yet to be done. The home provides three varied, nutritious meals each day and a snack supper. The menu is regularly reviewed and operates on a four-week rotation. Food records are kept. The daily menu is displayed in the reception hall and staff discuss daily choices with the Service Users. Five or six service users enjoy a cooked breakfast when they like it. Fresh fruit and vegetables are available. On the days of the inspection there was a Chef, Kitchen Porter and a waitress on duty at lunchtime. At teatime, the care staff serve the meals to service users in their rooms. The inspector was informed that this is difficult to achieve with three carers and several service users requiring assistance with their meal. On the day of the inspection the menu was as follows; Roast chicken and stuffing or Poached Haddock with vegetables, boiled and roast potatoes. This was followed by Apple and Blackberry pudding or ice cream. Special diets are catered for individually. The dining room is compact and comfortably decorated. Due to the size of the dining room most of the residents eat their meals sat in a wheelchair and this reduces the choice of where individuals can sit. It is recommended that attention must be paid to the posture of service users sitting in wheelchairs when taking their meal to ensure that the table can be reached properly and a position maintained to aid digestion. Over the lunchtime period the mealtime was observed. The Service Users were satisfied with the food, some spoke highly about what was available. The inspector was informed that the Environmental Health Officer (Food Hygiene) visited the home in February 2007 and had found everything satisfactory. The inspector was informed that all staff involved in the preparation of food are undertaking the recognised Foundation Food Hygiene training. The home’s chef has completed the Chartered Institute of Environmental Health Level 3 Award in Supervising Food Safety in Catering. No reflection of these choices/preferences or risk factors were noted within the care planning or risk assessments. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are aware of who they would speak to if they had any concerns. Staff have been provided with training on the action that they must take in the event of an allegation of abuse. EVIDENCE: There is an established complaints procedure for the home, which includes the contact details for the Department of Adult Social Care and Commission. The inspector was informed that all complaints and concerns are recorded, including the action taken and the outcome, however it was evident at the inspection that this is not the case. All complaints must be recorded. Service Users informed the inspector that they are aware of who they would speak to if they had a complaint and that the Registered Manager was very accessible. The Commission has not received any complaints since the last inspection. There is detailed information in an Adult Protection file about abuse including a copy of the Multi Agency policy for Cornwall. Internal training has been provided to all staff the inspector was informed and eleven staff have attended the externally facilitated Cornwall County Council training. Four staff had attended the Mental Capacity Act training. A safeguarding procedure including the contact details has been compiled, there is no evidence that staff have read and understood the procedure. Eleven staff have had POVA training. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment meets the needs of the Service User in a homely and comfortable way, with the exception of the bathrooms. These are clinical and could be made to be more homely. Individual accommodation is generally personalised. There are areas that could benefit from redecoration or cleaning. Service users stated that they liked their accommodation. EVIDENCE: The home is accessible, the location on the edge of Newquay and the layout of the home are suitable for its stated purpose. During a tour of the premises, areas of the home were observed to be in need of refurbishment, this has been identified by the Registered Manager. For example some carpets need replacing, cleaning or stretching to promote the safety of the residents and areas of the home. The sliding door in the lounge to a cupboard was observed still to be damaged as noted at the last inspection. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 18 Many rooms have excellent sea views and others enjoy far reaching countryside views. Residents informed the inspector that they liked their accommodation. There is a maintenance record book and a person is employed to do the maintenance in the home. Alarms are fitted on external doors. There is limited parking to the front and rear of the home. The environment was observed during this inspection. The home provides a range of shared facilities. These comprise the dining room, a large main lounge and a sea view lounge. The entrance hall is spacious and also provides a small seating area. Residents were observed choosing to sit in this area during the day. The furniture in communal areas is of a satisfactory standard and domestic in nature. There is plenty of natural lighting and adequate ventilation. There are no gardens but there is a patio area to the rear of the home with a pergola. There are two bathrooms with assisted baths on the ground floor. On the first floor there is a bathroom with assisted bath and a level entry shower. There is a shower chair for this facility. Generally the bathrooms were observed to be clinical and in need of upgrading. Most of the rooms have a toilet and wash hand basin. Additional toilets are located near the communal areas of the home. Service user’s preferences in relation to bathing should be recorded. As noted at the previous inspection the toilets including raised seats and bedpans were observed to need a thorough clean. One bath was observed to have a large plastic bag full of soiled pads in it. Communal soap and nailbrushes were observed. The rooms are individualised by their different shapes, sizes and décor. Rooms on the first floor have attractive sea or countryside views. There are a number of double rooms within the home, not all double rooms are occupied by two service users and suitable screening is in place in these rooms to afford privacy to both service users. The amount and style of the furniture is dependent on the size of the room – most were observed to have two chairs and a table plus adequate storage for clothes. Individual rooms are personalised and residents stated they were able to bring what they wished into the home depending on the space available. The inspector was informed that all rooms have a lockable space and all rooms are fitted with an over rideable lock. A new call bell system has been installed. There were areas of the home that required cleaning. The inspector was informed that there had been a shortage of housekeeping staff to maintain the standards in the home. Some carpets were noted to need cleaning and in some areas odours were evident. The laundry is located within the home, suitably placed away from where food is prepared or served. On the day of the inspection there was a considerable backlog of laundry to be done. Three baskets of wet laundry was waiting to be dried as there is only one tumble dryer increasing the risk of cross infection. The walls and in some places the floors are permeable and attention should be paid to this. Hand washing Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 19 facilities, supplies of gloves and aprons are available for staff. Laundry staff are on duty daily. Two industrial and one domestic washing machine are available. A member of staff informed the inspector that all laundry is carried out in the home. There are sluice facilities on the ground and first floor. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are not enough staff on duty at peak times to provide individualised care, activities or assist with meal times. All staff must be provided with the training to ensure that they have the skills and knowledge to meet the service users needs. Residents are safeguarded by a robust recruitment procedure, which operates within the home. EVIDENCE: Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 21 The inspector was informed that several staff have left and not been replaced. On the day of the unannounced inspection there was one nurse on duty with four carers (07.00 until 14.30) with a fifth until 11.00, for thirty-three service users. This is a reduction from the last inspection when there were five carers on duty for thirty-one residents. In addition to this there was the Registered Manager and administrator, supported by catering staff and ancillary staff. In the afternoon (14.30 until 22.00) there is one nurse and three carers. One person commented that the staff were very busy particularly ‘at bedtime’. There are three staff on duty at night including a qualified nurse. It has been identified that additional staff are required at mealtimes, however none of these shifts were covered on the day of the inspections. No agency staff are used. Residents continue to comment that staff seem very busy. The inspector was informed that the afternoon shift is very busy particularly at tea time with three carers having to assist with anyone requiring assistance and serve meals. Breakfast plates were observed to be in a resident’s room at 12.10. Residents are not able to choose the time that they get up, as it has to fit in with the routine of the home. Concerns have been expressed by residents, relatives and staff about the staffing levels and how this reduces the choice for the individual. On the day of the inspection over two thirds of the residents required two staff to meet their care needs. Staff work very hard to meet individual needs, their ability to do this is greatly reduced by the staffing ratio and levels of dependence. Staffing has been an ongoing issue at this home and an immediate requirement was issued to restore minimum staffing levels. Since the inspection the Registered Manager has agreed to ensure that there are six staff on in the morning including a qualified nurse, four staff in the afternoon and three staff at night. The inspector is informed that this is following discussion with the staff group. The Registered Manager must ensure that there are adequate staff on duty at peak times. Staff must be provided to cover sickness and absence, the current arrangements are failing the residents and staff working in the home. Advertisements have been placed to recruit care, cleaning and clinical staff. At previous inspections there have been eight staff on duty in the morning and five staff during an afternoon, including at least one trained nurse. This was with 38 Service Users. There is a staff rota that reflected the staff on duty. Service Users informed the inspectors that the staff were very good, but short staffed at times. Nine out of fifteen care staff have completed their National Vocational Qualification Level 2, this equates to sixty percent. There are four less care staff than at the last inspection. There is always a qualified nurse in charge of the shift. There are no staff employed under the age of eighteen years of age. The home has a recruitment policy and procedure in place that is followed when employing new members of staff. A robust recruitment procedure operates within the home including an enhanced CRB, POVA first and at least two written references to ensure the protection of service users. Evidence is obtained that trained nurses have renewed their registration with the Nursing Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 22 and Midwifery Council. All staff are issued with a job description, terms and conditions of employment and the General Social Care code of conduct. No new staff have started at the home since the last inspection. There had been a rolling programme for training in First Aid, Protection of Vulnerable Adults, Food Hygiene, Diet and Nutrition, Health and Safety and infection control, this has not been maintained. In November training is planned for food hygiene, infection control and basic life support. Staff must have the skills and knowledge to perform their role. The Registered Manager and inspector discussed the importance of qualified nurses undertaking regular training to ensure that they are up to date. Five out of the eight trained nurses recently attended a Syringe Driver training course. One of the staff provides fire training supported by an annual training session by the Fire officer. Training records are kept, as noted at the last inspection these require updating. New staff are being provided with a Skills for Care induction, however no new staff have started since the last inspection. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are areas of administration and management within the home that require urgent attention. The health and welfare of service user must be promoted and protected. All confidential records are not being stored securely. EVIDENCE: The Registered Manager is a registered nurse and has completed the Registered Manager’s Award. The clinical and managerial aspects must become more integrated to ensure effective care. Plans to have a ‘clinical and management handover’ daily have not transpired. It had been decided to have an ‘employee of the week’, this has not happened. After a period of time without a Registered manager, clear leadership is needed. Regular staff meetings are held and minutes are recorded. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 24 There is no evidence of recent quality assurance or continuous monitoring systems. An annual survey is planned. Policies and procedures have been reviewed, although these are standardised and often do not reflect the practices in the home. The Registered Manager aims to make himself accessible to service users and their families. An annual development plan for the home is required to promote continuous self-monitoring. Statutory requirements are identified at inspection, however timescales are not met. Actions are identified within the home however the inspector is informed that these are not followed through. No regulation 26 reports have been provided to the Commission since June. Following a requirement at the last inspection, changes have been made to ensure that the registered person does not pay money belonging to any resident into the home’s bank account. Receipts are kept and a record of monies entering and leaving the account. Service users have a lockable drawer in their rooms. A facility is available for the safe storage of valuables on behalf of service users and a receipt is provided. The inspector was informed that the Registered Provider does not act as an appointee or agent for any service users. Staff are not receiving regular formal supervision. Records are kept for meetings that are held, these are kept securely after a recommendation at the last inspection. The majority of supervision records are reflective of attendance at staff meetings and do not therefore demonstrate all aspects of practice, philosophy of care in the home and career development needs for the individual. Some staff have had an annual appraisal. Records required by regulation for the protection of service users must be maintained and kept up to date. Individual records such as confidential care documentation must be kept securely locked away in line with the Data Protection Act. Since the last inspection supervision records are being stored securely, however resident’s records are not locked away at all times. They are stored in an open office, which is readily accessible. At the last inspection environmental risks were observed, these had not been identified and so far as possible eliminated. The Registered Manager informed the Inspector that these matters have been addressed and risk assessment/management plans are in place. Window restrictors have been fitted to certain windows to reduce the risk to residents, however these are easily detachable. At the last inspection some individual’s windows were locked and they did not have the key, the inspector was informed that they did have their keys now. The radiators were observed to be covered to reduce hot surfaces and hot water is regulated, the Manager informed the inspector that there were maintenance checks in place to monitor this and legionella. All accidents are recorded in the accident book, however the pages have not been removed in line with Data Protection legislation, this was the same at the Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 25 previous inspection. There is evidence that servicing of equipment takes. Door alarms are fitted on external doors and the front door is locked. Unlabelled cleaning substances were observed in the bathroom. It was evident that container were being refilled as label stated ‘do not throw away’. The inspector was informed that the Registered Manager is a Moving and Handling trainer, eleven staff have had moving and handling training Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 X X 3 X 2 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 2 2 Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Timescale for action 01/12/07 2. OP12 16(2n) The registered person shall after consultation with the service user, or a representative prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall make the service user’s plan available to the service user, keep under review, consult with the service user and revise the care and notify the service user of any revision. Previous timescales not met 01/08/07 The registered person shall 01/12/07 consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including having regard to the needs of service user, activities in relation to recreation, fitness and training. Previous timescales not met 01/11/07 3. OP14 12(2&3) The registered person shall, for the purpose of providing care to service users and making proper provision for their health and DS0000041356.V350294.R01.S.doc 01/12/07 Newquay Nursing Home Version 5.2 Page 28 welfare, so far as practicable ascertain and take into account their wishes and feelings and enable them to make decisions with respect to the care they are to receive e.g. service user’s preferences in relation to food, mealtimes, personal and social relationships, leisure and social activities and routines of daily living should be documented. Previous timescales not met 01/08/07 4. OP27 18(1a) The Registered Provider is 11/10/07 required to maintain minimum staffing levels. The Registered Person shall having regard to the size of the care home and the number and needs of the Service Users ensure that at all times suitably qualified, competent and experienced persons are working in the care home in such numbers as are appropriate for the health and welfare of Service Users. Previous timescales not met 01/08/07 5. OP30 18(1c) The Registered Provider is required to ensure that persons employed at the care home receive training appropriate to the work they are to perform and suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. e.g. Prep Previous timescales not met 01/02/08 6. OP31 10 7. OP33 24 The registered manager shall having regard to the size of the care home, the number and needs of the residents, manage the care home with sufficient care, competence and skill. The registered person shall establish and maintain a system for reviewing and improving the DS0000041356.V350294.R01.S.doc 01/12/07 01/02/08 Newquay Nursing Home Version 5.2 Page 29 quality of care at the care home, including the quality of nursing where nursing is provided. Previous timescales not met 01/11/07 8. OP36 18(2) The Registered person shall ensure that persons working at the care home are appropriately supervised. Previous timescales not met 01/11/07 01/02/08 9. OP37 Data Protection Act 1998 States that anyone who processes personal information must comply with eight principles, for example make sure that personal information is secure. Confidential information must be locked away securely and removed from the Accident book. Previous timescales not met 01/08/07 01/02/08 10. OP38 13(4) The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Previous timescales not met 01/08/07 01/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP1 OP8 OP9 OP12 Good Practice Recommendations For the service user’s views of the home to be included in the Service user’s Guide and for this document to be provided to all prospective residents. For regular dental and optician visits to the home to be recommenced. For handwritten Medication Administration Records (MAR) to be checked and signed by a second person. For the member of staff conducting activities to be DS0000041356.V350294.R01.S.doc Version 5.2 Page 30 Newquay Nursing Home 5. 6. 7. 8. 9. OP21 OP21 OP26 OP31 OP38 provided with training to facilitate this role. To make the bathrooms less clinical and more homely. For deep cleaning to be undertaken of all the bathing and toilet facilities. The laundry floor covering be replaced to ensure the surface is impermeable. For clinical and managerial aspects to become more integrated and there to be evidence of clear leadership. For cleaning liquids to be used with correct labelling, in adherence with health and safety legislation. Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Newquay Nursing Home DS0000041356.V350294.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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